Availability of addiction medications in private health plans

Abstract

Health plans have implemented cost-sharing and administrative controls to constrain escalating prescription expenditures. These policies may impact physicians' prescribing and patients' use of these medications. Important clinical advances in the pharmacologic treatment of addiction highlight the need to examine how pharmacy benefits consider medications to treat substance dependence. The extent of restrictions influencing availability of these medications to consumers is unknown. We use nationally representative survey data to examine the extent and stringency of private health plans' management of naltrexone and disulfiram for alcohol dependence, and buprenorphine for opiate dependence. Thirty-one percent of insurance products excluded buprenorphine from formularies, while 55% placed it on the highest cost-sharing tier. Generic naltrexone is the only substance dependence medication that is both rarely excluded from formularies and usually placed on a lower cost-sharing tier. These findings demonstrate that pharmacy benefits have an impact on access to medications to treat substance abuse.

Disparities in Access to Physicians and Medications for the Treatment of Substance Use Disorders Between Publicly and Privately Funded Treatment Programs in the United States

“…Our fi ndings highlight the continued existence of a twotiered SUD treatment system (Horgan et al, 2008;Rodgers and Barnett, 2000;Wheeler and Nahra, 2000) with less access to staff physicians and fewer medications prescribed in publicly funded treatment programs. Strategies for reducing disparities in access to high-quality SUD treatment may include integration with mainstream health care settings and increased SUD-specifi c training for physicians.…”

“…The remainder-privately funded programs-are largely dependent on revenues from private insurance and self-paying patients (Roman and Johnson, 2002). Disparities in treatment services may be associated with these differences in program funding, with patients seeking treatment in privately funded programs receiving higher quality care (Horgan et al, 2008;Rodgers and Barnett, 2000;Wheeler and Nahra, 2000).…”

A Longitudinal Examination of Alcohol Pharmacotherapy Adoption in Substance Use Disorder Treatment Programs: Patterns of Sustainability and Discontinuation

“…Funding policies might represent a critical barrier to adoption if funding entities, such as Medicaid and private insurance plans, will not cover the costs associated with prescribing medications or they set high co-payments for these medications (Horgan et al, 2008;Thomas et al, 2011). A recent study found that funding policies, particularly those that do not allow reimbursement for costs associated with medications, were a major barrier to adoption among publicly funded programs (Knudsen et al, in press).…”

Improving Treatment for Opioid Dependence: A Perspective From the Ohio Valley Node of the NIDA Clinical Trials Network

“…13–14 Among publically funded substance abuse treatment programs in the U.S., only 11.4% of programs provide methadone and 18.4% provide buprenorphine. 13 There are several explanations for why there is limited use of medications to treat addictions: lack of financial resources to pay for addiction medications at the state, program, or patient levels; 15–17 lack of medical staff with prescribing privileges; 17 physicians’ reluctance to prescribe medications for addictions; 14,18–19 and regulatory dispensing barriers. 5,17 For some treatment programs and clinicians, the barrier may be the philosophical belief that medications should not be used to treat addictions despite the overwhelming evidence of efficacy and effectiveness.…”